- A spontaneously breathing patient in need of intubation (inadequate respiratory effort, evidence of hypoxia or carbon dioxide retention, or need for airway protection).
- Rigidity or clenched teeth prohibiting other airway procedures.
- Patient must be 12 years of age or older.
- Premedicate the patient with nasal spray.
- Select the largest and least obstructed nostril and insert a lubricated nasal airway to help dilate the nasal passage.
- Preoxygenate the patient. Lubricate the tube. The use of a BAAM device is recommended.
- Remove the nasal airway and gently insert the tube keeping the bevel of the tube toward the septum.
- Continue to pass the tube listening for air movement and looking for “to-and-fro” vapor condensation in the tube. As the tube approaches the larynx, the air movement gets louder.
- Gently and evenly advance the tube through the glottic opening on the inspiration. This facilitates passage of the tube and reduces the incidence of trauma to the vocal cords.
- Upon entering the trachea, the tube may cause the patient to cough, buck, strain, or gag. Do not remove the tube! This is normal, but be prepared to control the cervical spine and the patient, and be alert for vomiting.
- Auscultate for bilaterally equal breath sounds and absence of sounds of the epigastrium. Observe for symmetrical chest expansion. The 15mm adapter usually rests close to the nostril with proper positioning.
- Inflate the cuff with 5-10 cc of air.
- Confirm tube placement using an end-tidal CO2 monitoring or esophageal bulb device.
- Secure the tube.
- Reassess airway and breath sounds after transfer to the stretcher and during transport. These tubes are easily dislodged and require close monitoring and frequent reassessment.
- Document the procedure, time, and result (success) on/with the patient care report (PCR).
- It is required that the airway be monitored continuously through waveform capnography and pulse oximetry.